WHAT’S THE DIFFERENCE BETWEEN FUE AND FUT?

At San Diego Hair MD, we see many men and women each week for both medical and surgical treatment of hair loss. One of the most common questions I’m asked by my patients is to explain the terms FUE and FUT. Are they the same? What do the letters stand for?

FUE is an abbreviation for follicular unit extraction. FUT is the abbreviation for follicular unit transplantation also known as the strip technique. I tell my patients to remember that hairs grow out of the scalp from the bulb which is located deep in the skin. However, the number of hairs which grow together out of the scalp varies from person to person and even region of the scalp. This is called the follicular unit and the number of hairs per follicular unit vary from one to four (occasionally five).

We use this knowledge of follicular units when performing hair restoration procedures. The oldest method to extract or remove hair from the back of the head for transplantation is called FUT and consists of excising a large segment of scalp containing hair follicles. The defect which is created is then closed with sutures or staples. This piece of scalp is then divided into follicular units using a scalpel under magnification, often a microscope.

It is these follicular units which are ultimately transplanted into balding areas of the scalp like the frontal and crown regions. Patients who have undergone FUT and seek another hair restoration procedure often describe this as a rather painful procedure. This is probably because it’s somewhat invasive and nerves to the scalp are often encountered and divided or cut.

The scalp is often closed under some tension resulting in swelling and moderate pain during the recovery period. Sutures are generally removed within a week. Long term problems with the FUT method include permanent scalp numbness, a long scar along the back of the head, and thinning of hair around the scar which can make it hard to conceal with short hair.

In contrast, the FUE method of hair restoration is a much newer method and involves the selective removal of individual follicular units with a tiny punch, often under 1 mm in diameter. The device used may be semi automated as with the Neograft or Smart Graft machine, or fully automated as with the Artas robotic system. No sutures or staples are needed as the tiny sites heal on their own leaving no long, linear scar along the back of the head. In addition, the extraction is relatively superficial as compared to the FUT method resulting in less pain and numbness of the donor scalp. No tension is placed upon the scalp so hair thinning is less of an issue.

Patients in our practice who seek further hair restoration following a previous FUT procedure are often hesitant to undergo a second procedure. This is because they often remember the pain, swelling, and prolonged recovery associated with their first procedure. After the FUE procedure using the Neograft device, most of my patients remark that both the procedure and associated recovery were much easier this time versus their experience with the FUT or strip method. This makes sense to my patients when I explain that the newer FUE technique is similar to advances which have occurred in other surgical fields like general surgery and orthopedic surgery.

For instance, gall bladder surgery used to involve creating a large incision in the upper abdomen to access the gall bladder for its removal. The recovery was prolonged in part due to the extensive incision and dissection with this older method. Patients were often required to remain in the hospital for several days.

However, all that has dramatically changed. Most gall bladder surgery is now performed as an outpatient procedure using small incisions and insertion of laparoscopic instruments. Pain and recovery have been significantly reduced. The same is true in orthopedic surgery when it comes to joint surgery. Many procedures that used to require large incisions can now be performed using tiny incisions just large enough to insert endoscopes that can repair torn ligaments.

FUE is gradually replacing FUT as the primary method of hair restoration just as the endoscope and laparoscope have replaced the older open methods in other surgical fields. Technological advances continue to improve patient care and outcomes in all medical and surgical fields. This is an exciting time for both patients and physicians who are involved in hair restoration too!

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